Simple nephrectomy: retroperitoneal approach

Complications prevention of shoulder balance support device for lateral decubitus position: A randomized controlled trial

Objectives

The authors invented the shoulder balance support device aiming to prevent skin complications and neck pain in surgical patients operated in lateral decubitus position. This study aimed to compare skin complications and neck pain between patients with shoulder balance support device and traditional positioning instruments and to assess surgeons' and anesthesiologists' satisfaction in using the device.

Methods

A randomized controlled trial, which followed Consolidated Standards of Reporting Trials(CONSORT) statement, was conducted in patients who underwent laparoscopic upper urinary tract surgery in the lateral decubitus position from June 2019 to March 2021. The shoulder balance support device was used in 22 patients and 22 other patients were in the control group. The area of skin erythema, bruising, or abrasion resulting from the pressure effect of the lateral decubitus position was measured and the pain score for the neck and shoulder area after the operation was assessed. Furthermore, the satisfaction of the medical personnel taking care of the patients and using the shoulder balance support device was investigated.

Results

A total of 44 patients were included. No patient in the intervention group reported neck pain. Skin erythema was found in six patients in each group and the median area of skin erythema was significantly smaller in the intervention group. Most of the medical personnel reported satisfaction with use of the device.

Conclusion

This device is an innovative tool with the aim of ultimate care for surgical patients.

Clinical Trial Registration Number

Thai Clinical trials registry ID TCTR 20190606002.

Hand-assisted laparoscopy confers equal efficacy in simple and radical nephrectomy

These authors conclude that hand-assisted laparoscopic simple nephrectomy may be associated with similar operative times, length of postoperative stay, and comparable complication rates as those of hand-assisted laparoscopic radical nephrectomy.

Background and Objectives:

To evaluate outcomes for simple hand-assisted laparoscopic nephrectomy (HALSN).

Methods:

A retrospective chart review was performed at our institution for all patients who had undergone HALSN from January 2002 to January 2009. Thirty-three patients underwent HALSN during this time period and were matched with 33 patients who underwent radical hand-assisted laparoscopic nephrectomy (HALRN).

Results:

Operative times were similar between both groups (301 vs 286 min for HALSN vs HALRN; P=.54). There were no intraoperative or postoperative transfusions in either group. There was one conversion to open nephrectomy in the HALSN group in a patient with xanthogranulomatous pyelonephritis and no conversions in the HALRN group. The mean opioid equivalence requirement was not statistically different between both groups (110 vs 120 for HALSN vs HALRN, P=.70). Mean hospital stay was similar for patients undergoing HALSN and HALRN (5.0±3.8 days vs 4.0±1.2 days, P=.63). There was 1 major complication in the HALSN group (pulmonary embolus) and no major complications in the HALRN group. Rates of minor complications were comparable between the 2 groups (18% vs 24% for HALSN vs HALRN).

Conclusions:

HALSN may be associated with similar operative times and length of postoperative hospital stay as well as comparable complication rates compared to HALRN.

Laparoscopic renal surgery for benign disease

Fifteen years after the first report, laparoscopic nephrectomy has demonstrated proven efficacy and safety comparable with an open approach, with a significant advantage of a faster recovery. Wide dissemination of these surgical techniques and continued improvement in instrumentation has made laparoscopy the preferred approach for treating benign pathologic conditions of the kidney. In this review, the expanding indications of laparoscopic simple nephrectomy and the outcomes of the larger clinical series are examined. We discuss the technical aspects of both transperitoneal and retroperitoneal approaches. Finally, laparoscopic cyst decortication and some of the novel applications of laparoscopic renal surgery are highlighted.

Laparoscopic nephrectomy: the new gold standard?

Laparoscopic nephrectomy has lesser blood loss, quicker recovery and return to work, shorter hospital stay, lesser post operative pain and analgesia requirement associated with it compared to open nephrectomy along with having oncological equivalence to open nephrectomy for T1, T2 renal tumours and for level 1 renal vein invasion by tumour thrombus. It has assumed the status of the New Gold Standard.

Should retroperitoneoscopic nephrectomy be the standard of care for benign nonfunctioning kidneys? An outcome analysis based on experience with 449 cases in a 5-year period

PURPOSE

Laparoscopic nephrectomy has become a routine procedure at specialized centers with the advantages of less postoperative pain, minimal scars, rapid recovery and short convalescence. We report our experience with the establishment of retroperitoneoscopic nephrectomy as the standard of care for benign nonfunctioning kidneys.

MATERIALS AND METHODS

We retrospectively compared the records of patients who underwent simple nephrectomy retroperitoneoscopically or by open surgery from January 1998 to October 2003 at our center.

RESULTS

A total of 351 simple nephrectomies were done retroperitoneoscopically, while 83 were done as an open procedure. Mean operative time was significantly longer in the retroperitoneoscopic group. However, mean blood loss, complication rate, hospital stay and convalescence were significantly less in the retroperitoneoscopic group.

CONCLUSIONS

Retroperitoneoscopic nephrectomy has become a standardized procedure. It should be offered as the primary treatment modality to patients with benign renal disease scheduled for elective nephrectomy except in those in whom it is contraindicated.